Rerknimitr Rungsun, Attasaranya Siriboon, Kladchareon Nusont, Mahachai Varocha, Kullavanijaya Pinit
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2002 Jun;85 Suppl 1:S48-53.
Currently the best curative therapy for primary malignant biliary tumor is surgery. Unfortunately, many patients present at a very late stage and only palliative biliary drainage is possible. Usually nonsurgical palliative biliary drainage means either percutaneous or endoscopic approach. In this series, the authors reported the rate of technical success and immediate complications in patients with malignant biliary obstruction who underwent endoscopic biliary drainage. From endoscopic retrograde cholangiopancreatography (ERCP) database between September 2000 and October 2001, there were 273 ERCP performed for obstructive jaundice. Of these, 50 patients with malignant tumor underwent 80 procedures for endoscopic biliary drainage. The patients were divided into three groups according to the cholangiographic findings and clinical diagnoses. Patients with carcinoma of the pancreatic head were categorized as group I (n=10). Group II (n=20) and III (n=20) were patients with extrahepatic cholangiocarcinoma and hilar cholangiocarcinoma respectively. All patients received either plastic or metallic endoprothesis placement for biliary drainage. All patients except two in group I had successful endoscopic treatment. Complications in group I, II and III were 15.4 per cent, 14.3 per cent and 53.1 per cent respectively. Only one patient in group II developed significant hypotension during the procedure. Another complication was defined as post procedure cholangitis. In conclusion endoscopic biliary drainage was technically feasible in 97.5 per cent of patients who had malignant biliary obstruction. In patients with hilar tumor the incidence of post procedure cholangitis was high (53.1%). Improvement in technique, avoiding unnecessary contrast injection, and draining the obstructed bile duct after injecting the contrast may improve the outcome and decrease the rate of post procedure cholangitis in these patients.
目前，原发性恶性胆管肿瘤的最佳治疗方法是手术。不幸的是，许多患者就诊时已处于晚期，只能进行姑息性胆管引流。通常非手术姑息性胆管引流指的是经皮或内镜途径。在本系列研究中，作者报告了接受内镜胆管引流的恶性胆管梗阻患者的技术成功率和近期并发症发生率。从2000年9月至2001年10月的内镜逆行胰胆管造影（ERCP）数据库中，因梗阻性黄疸共进行了273例ERCP检查。其中，50例恶性肿瘤患者接受了80次内镜胆管引流手术。根据胆管造影结果和临床诊断，将患者分为三组。胰头癌患者归为I组（n = 10）。II组（n = 20）和III组（n = 20）分别为肝外胆管癌和肝门胆管癌患者。所有患者均接受了塑料或金属内支架置入术进行胆管引流。I组除两名患者外，所有患者的内镜治疗均成功。I组、II组和III组的并发症发生率分别为15.4%、14.3%和53.1%。II组只有一名患者在手术过程中出现了严重低血压。另一种并发症定义为术后胆管炎。总之，内镜胆管引流在97.5%的恶性胆管梗阻患者中技术上是可行的。在肝门部肿瘤患者中，术后胆管炎的发生率较高（53.1%）。改进技术、避免不必要的造影剂注射以及在注射造影剂后引流梗阻胆管可能会改善这些患者的治疗效果并降低术后胆管炎的发生率。
